A while ago the wonderful @ivffervescent collated questions from the infertility twitter and blog world about DHEA, and worked with the Center for Human Reproduction in New York to get us some answers to these questions. Unfortunately, @ivffervescent had some ‘identity issues’ with her blog and had to delete it, and is therefore unable to publish the Q&A. Which is where I come in. Never one to turn down an opportunity to look like a super hero without actually having to do any work I agreed to publish the results on her behalf. So….
Disclaimer: The answers are general recommendations, and that readers should consult their physician or knowledgeable reproductive endocrinologist before they start DHEA supplementation.
Question 1 (submitted by On Fecund Thought / @onfecundthought )
a) How is DHEA thought to improve egg quality exactly?
DHEA is converted into androgens (mostly testosterone) in the body. CHR’s research (following findings in animal studies) has shown in recent years that diminished ovarian reserve is an androgen-deficient state (paper: http://www.ncbi.nlm.nih.gov/pubmed/23427231), meaning that the ovaries of women who suffer from diminished ovarian reserve have abnormally low androgen (testosterone) levels.
While androgens have been considered detrimental to female fertility for a long time, CHR’s research suggests that having an appropriate level of androgens in the ovaries is actually beneficial to healthy development of eggs. While we do not know the exact mechanism of how androgens support follicular development, immature eggs that go through the maturation process in an androgen-rich environment in the ovaries appear to mature into higher-quality eggs than those that spent this 3-4 month period in an androgen-deficient ovarian environment. By supplementing the ovarian environment with testosterone via DHEA supplementation, we seem to be able to improve egg quality in women with diminished ovarian reserve. (More information about how all of this works is available at http://www.fertinatal.com/improve_egg_quality_with_fertinatal_dhea.php.)
b) Assuming the recommended dose is 25mg 3x a day, why is it more effective to spread out the doses, as opposed to one 75mg dose?
We don’t know if it’s more effective to spread out the dose, but we recommend taking DHEA with meals to avoid upset stomach.
c) What’s the difference between DHEA and CoQ10? Is one better than the other, or are they best taken in conjunction?
DHEA is a natural hormone produced in the body, a precursor to various other hormones, especially testosterone. CoQ10 is also naturally present in the body, and acts as antioxidant as well as an intermediary in the energy production process within cells. Animal and human studies have shown that they both contribute to female fertility via improved egg quality and quantity. However, the mechanisms through which DHEA and CoQ10 achieve these things are quite different.
- DHEA improves egg quality (as well as improves pregnancy chances, reduces chromosomal abnormalities in embryos, reduces miscarriage rates, etc.) by giving eggs an optimal, androgen-rich ovarian environment in which they go through their final maturation process. CoQ10 appears to improve egg quality by protecting the eggs’ DNA as well as mitochondrial DNA within the eggs—this is CoQ10’s antioxidant function.
- CoQ10 also plays a crucial role in the energy production within the mitochondria, which supplies energy to eggs as they develop. As energy deficiency can lead to chromosomal abnormalities in eggs, this CoQ10’s role is also considered important for good-quality eggs.
There is more direct evidence for DHEA than CoQ10; however, CHR sometimes uses CoQ10 in conjunction with DHEA on a more experimental basis.
d) Is a higher dose of DHEA recommended for women with low antral follicle counts?
No. CHR monitors women on DHEA supplementation for testosterone levels (free and total testosterone), not with AFCs. For women whose testosterone levels do not rise after at least 6 weeks of DHEA supplementation, we use direct testosterone supplementation (either in our testosterone clinical trial or outside of the trial).
e) How long before starting IVF should you take DHEA? What’s the minimum time?
Because the final maturation process of eggs takes months, CHR uses DHEA supplementation for at least 6 weeks before IVF cycle start, so that the eggs that are retrieved after ovarian stimulation have gone through their maturation process in an androgen-rich ovarian environment.
CHR also monitors the testosterone levels of women on DHEA supplementation, and does not start IVF cycle until the testosterone levels are in the high normal range. (Study: http://www.ncbi.nlm.nih.gov/pubmed/23212832)
f) Does any research show that egg quality can be improved with DHEA when a woman has been pregnant before?
Yes, many patients who come to CHR have had babies before, and they still benefit from DHEA supplementation if their ovarian reserve has become low.
Question 2 (submitted by The Infernal Infertile)
As an aging woman with a low AMH who is also a “poor responder” to treatment… I’d like to know: Is there any evidence that DHEA could improve the body’s response to treatment – as well as improve overall quality of eggs?
Yes, in CHR’s experience, DHEA improves response to ovarian stimulation (i.e., women produce a larger number of better quality eggs after stimulation).
Question 3 (submitted by @hopeinour_heart)
I did ask my RE about it as I have low AMH & he said that only some women benefit from DHEA… & he could tell from some blood test of mine it wouldn’t be of benefit to me?!?!
Yes, it is true that some blood test results can tell you whether you need DHEA or not. If you have testosterone values in the upper one-third of normal range, you don’t need DHEA supplementation. If your testosterone is lower than that, you need it. (Study: http://www.ncbi.nlm.nih.gov/pubmed/23212832)
Question 4 (submitted by me!!)
Are you going to do a well powered Randomised Controlled Trial to see if it actually works?! And… Where can I point my Doctor to, to improve his knowledge of DHEA’s potential role in fertility treatment?
There has been only one randomized controlled trial on DHEA’s effects on women’s fertility. This Israeli study (http://www.ncbi.nlm.nih.gov/pubmed/20729538) is very small, but did show the positive effects of DHEA. CHR has tried in the past to conduct RCTs on DHEA, but we have had to abandon the trials due to low enrollment. Understandably, women who are trying to get pregnant at advanced ages really do not want to risk getting randomized into placebo group. At this time we do not have a plan for another RCT on DHEA.
Question 5 (submitted by Yet Another Bitter Infertile / @infertile_me)
“Evidence? Side effects? Dosages? Contraindications?” Are there supplements/drugs that should not be taken with DHEA? Can it be taken during pregnancy or should I stop once I get a +HPT or even earlier?
Women who take prescription medications should not start DHEA without consulting their physician first, as some drugs may interact with DHEA. In addition, there are conditions that can be affected by DHEA supplementation, such as diabetes, mood disorders and estrogen-sensitive cancers. This is a part of the reason CHR doesn’t recommend self-supplementation with DHEA. DHEA should be stopped once pregnant, because the body produces enough DHEA during pregnancy.
Question 6 (submitted by Isabelle)
What about if DHEA does the following to a person: increased hair growth, loose stool, and acne? What is the right dosage? Does it depend on a person’s testosterone level, DHEA sulfate level, or both? What exactly does it do to egg quality? How many months is recommended?
DHEA does have some side effects, although loose stool is not commonly associated with DHEA. Most DHEA side effects are mild, and disappear once supplementation is stopped. If a side effect does not go away, you should consult your physician.
Question 7 (submitted by The Infertile Chemist)
Can DHEA cause weight gain?
Weight gain is not a commonly recognized side effect of DHEA.
Question 8 (submitted by @Sams_ttc_story)
I’ve heard DHEA is not safe/advisable to take if youre hypothyroid or on thyroid meds? Contra indicated?
There is no evidence that DHEA is contraindicated in women with hypothyroidism or those who are on thyroid medications.
Question 9 (submitted by My Assisted Conception Journey / @SubFertileChick)
Would DHEA help women with DOR if they were trying to conceive a 2nd child naturally after IVF? if so, what would be recommended dose & how long would it be safe to take for xxx
DHEA improves spontaneous pregnancy rates. General recommendation is 75 mg daily (25 mg 3 times daily). Based on how we use DHEA supplementation leading up to IVF cycles, at least 6 weeks of supplementation is also recommended for trying for spontaneous pregnancies.
If you’d like to know more about the CHR, their website is: www.CenterForHumanReprod.com
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